Solrx Pharmacy review book for Qualifying Exam-2(OSCE)
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International Pharmacy
Graduate Comprehensive
Pharmacy Review Program
For Qualifying Exam -2 (OSCE)
Published by: OSprep INC.
Canada’s Leading Pharmacy Review Program
Prepared by:
Vipul Shah B.Sc. RPh. MBA
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Table of Content
Sr. No.
1
DESCRIPTION
Pg. No
Rx Counselling Basic
6-12
2
Brand and Generic names of top drugs
13-21
3
New recently introduced medications
22
4
Rx counselling cases
5
Few products with important instructions like storage, priming
shaking etc
84-95
6
OTC recommendation - Basic
96-103
7
Most commonly used OTC products
104-113
8
OTC recommendation: Cases
114-148
9
Basic questions for OTC recommendations for few topics
1 to 19
20-41
23-83
149-157
10
Health-care cases: Basic
158-160
11
Health-care cases
161-187
42-50
12
Managements cases
13
Demonstration of devices and few products: Basic
51-64
188-204
205-208
14
Cases 65-71
209-219
15
Basic of references used for osce
220-227
16
Rx scanning: Basic
228-230
17
Rx scanning: Cases:
18
Dispense checking: Basic
19
72-106
Cases 103-122
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231-239
240-241
242-255
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Important Disclaimer
This book is not reviewed by Pharmacy Examining Board of Canada or any other organization.
The book is not recommended by Pharmacy Examining Board of Canada or any regulatory body.
The purpose of the book is to provide orientation towards the Qualifying Exam - 2 (OSCE)
conducted by Pharmacy Examining Board of Canada. The exam structure or assessment criteria
may be changed by Board and hence, the same information and orientation provided in this
book may not be relevant in future.
The authors and publishers assume no liability for any loss due to use of this book. While care
has been taken to ensure that the information provided herein is accurate and up to date, it is
recommended that in case of any doubt, matter should be referred to a professional or the
regulatory body.
The authors and publishers do not have access to the exam stations of Pharmacy Examining
Board of Canada and any stations or cases mentioned in the Book should not be assumed as a
part of upcoming or previous exams.
On the author’s part, it required significant amount of interpretation & extrapolation of the
information provided by Pharmacy Examining Board of Canada on its website. This means that
the expectation set out by the authors and the board may vary significantly. The author and
publishers assume no liability for this.
Finally, this book does not guarantee a PASS. The purpose of this book is to help orient you
towards the exam.
** PEBC is a trademark of Pharmacy Examining Board of Canada and NOT related to OSprep
INC. **
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Rx counseling
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Communication: The literal meaning of communication is an INTERCHANGE of thoughts,
opinions or information by speech, writing or signs.
• 38% of your score will be based on your communication for OSCE exam.
• OSCE is NOT only about your knowledge, but about the application of knowledge in health
care setting to ensure complete patient care through an interaction.
• Interactions require communication: written and/or verbal.
So what is communication in relevance to OSCE?
The ‘TOTAL’ presentation you deliver in your interaction with the patient or other
healthcare providers.
VERBAL
It’s all about what you say and how you say it.
Speaking: It’s very important to pay special attention, when you communicate with your
patients. Sometimes your gestures you think as normal could be extremely offensive, or simply
wrong, and vice versa. Choose your words carefully as blurting out wrong words can simply
cause you trouble or unnecessary embarrassment.
Example 1: Choice of words may HARM the patient?
While counseling for Prozac 20 mg:
Pharmacist: “Your doctor prescribed you this medication to treat your DEPRESSION”
Patient: “I DO NOT HAVE DEPRESSION. I ONLY HAVE LOW MOOD. I AM NOT GOING TO TAKE
THIS MEDICATION!!!”
Here, the pharmacist should have started by asking why the doctor prescribed the
medication.
Example 2: While counseling for ACE inhibitor:
Pharmacist: “Your doctor has prescribed you this medication for hypertension”
Patient: STARTS USING THE MEDICATION WHEN HE FEELS STRESSED OUT OR WHEN HE HAS
TENSION.
The Pharmacist should have used simple layman language. “High Blood Pressure
Medication” instead of “Hypertension”
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Key points you need to keep in mind while speaking:
O
Be loud and clear
o Use layman language with patient
o Use medical language with health care provider
o Be precise, do not be repetitive
o BE CONFIDENT!
Listening: It is a key component to SUCCESSFULLY passing each individual station.
Pay special attention to the opening statement – it will give you the THEME/ JIST of the
individual station.
If you did not hear the first time, ask politely to repeat and DO NOT make assumptions!
NON-VERBAL
It’s about delivering a message without talking. It depends basically on your gesture, body
language, look and the way you approach situations.
o Posture and Mannerisms
o Personal space (Maintain at 5-7 meter distance)
o Facial expression - Being pleasant excited, or sympathetic as per the condition
o Eye contact
Empathy
The intellectual identification of feelings, thoughts, or attitudes of another person’s experience
OR the ability to put oneself in other person’s shoes.
It has to be GENUINE AND APPROPRIATE.
Do not say that you “UNDERSTAND” instead use words like “APPRECIATE” or “IMAGINE”
Example 1: A patient comes into the pharmacy complaining about pain
“I can see that it is really bothering you”
“I will definitely try to help to relieve your pain”
“I will surely help you with that”
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Example 2 : A patient comes in complaining about lack of sleep
“I can see that you look tired today”
“It must be hard for you”
“I hope this medication gives you the restful sleep you deserve”
Less is more: In communication, less is more. Listening is as important part of communication
as speaking. Even while you speak, remind yourself to be as precise as possible. Do not keep
repeating yourself.
Open ended versus Closed ended Questions: Both type of questions have their importance.
Usual way of starting communication is to ask open ended questions to gather information and
then follow up with Closed ended question to come to a conclusion.
Example: Patient comes in for recommendation on cough and cold
You start with open ended questions: “Tell me more about your problem.”
“What else should I know? Is there anything else that I should know of?”
After basic information gathering, you can quickly reach a conclusion by asking Closed
ended questions like:” Any fever? Any form of allergies?”
Following the Template: It is important to follow a template to ensure your success in the
exam. The template allows you to gather all relevant information quickly and completely. It also
allows you to communicate in an organized way in interactive stations.
The template allows you to:
o Not to miss out on important points supplied by the patient
o Avoid repeating your questions
o Stay organized
o Stay focused
You will find out more about templates in the coming chapter. It takes a lot of practice to be
able to deliver what you mean and how you want the patient to understand it.
Also stay alert, because it is an art to pick up on verbal and non-verbal clues from the patient.
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Detailed template for Rx stations
INTRODUCTION
Introduce yourself: Hello. My name is _____ I am the pharmacist on duty today. How may I help
you?
Identify the Patient: Is this prescription for you?
Are you Mr. (Last Name)? Is it ok if I address you as (First Name?)
Offer privacy and confidentiality: To ensure the accuracy of this prescription and provide proper
counseling, I need to ask you a few questions. Is that okay with you? Please be seated in our
private counseling area and whatever we discuss will be confidential. Please feel free to ask me
any questions you may have.
INFORMATION GATHERING
MEDICAL INFORMATION: Reason for visiting the doctor: What made you see the doctor?
Has this medication been used before: Have you ever tried this medication before?
Have you tried anything else to treat this condition before?
Medical Conditions: Do you have any medical conditions that I should know of?
Besides this, do you have any other medical conditions? (Continue until patient runs out of all
his/her conditions)
Allergies, Severity of allergy: Do you have any known drug allergies? Any environmental or food
allergies? (If yes) What happened when you got the allergic reaction? (Distinguish between true
allergy and Intolerance/side effect)
Rx Medications: Are you taking any prescription medications? (If yes) How are you doing with
them? (Continue until the patient runs out of medications)
Herbal, OTC Medications: Are you taking any over the counter medications like Tylenol or Advil?
Are you taking any herbals, vitamins or mineral supplements?
Pregnancy and Breastfeeding if women 18 - 48: Some medications may not be indicated in
pregnancy or breastfeeding. So, can you let me know if you are pregnant or breastfeeding.
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SOCIAL HABITS AND LIFESTYLE INFORMATION: [NOTE: Ask patient permission if you can ask
them questions about their lifestyle] Sometimes, our lifestyle may affect the disease and the
way medications work. May I ask you a few questions about your lifestyle?
Caffeine: Can you tell me if you take any caffeinated beverages like coffee, tea or cola? (If yes)
May I ask how many per day?
Alcohol: Do you consume alcohol? If yes, how many drinks per week?
Smoking: How about smoking? How many packs per day?
Exercise: Do you find time to exercise regularly?
Diet: How would you describe your diet?
(If the patient’s lifestyle is good and healthy, it is a good idea to appreciate it)
CHECKING REFERENCE
[NOTE: Ask permission to look at reference and get back to the patient] Is it okay, if I check my
reference and come back to you?
COUNSELING
What information did the doctor give about the medication: What did the doctor tell you about
this medication?
Drug: brand name, generic name, strength, dosage and duration of treatment: The doctor has
prescribed (Brand name) which contains (Generic name) in the strength of _____. Your doctor
wants you to take (dosage e.g. one tablet once a day at roughly the same time every day.).
Continue taking for ____ days.
With or without food: This medication is best taken before/after food. (Give reason). You can
take this medication with or without food, either ways it works fine.
Purpose of medication, how it works and onset: This medication is for _____________. It works
by _______ and thereby controls/helps with _________. It will provide immediate effect/ it may
take some time up to _____before you can see the effect. It must be taken every day for it to be
effective. / It should be taken as and when needed
Side effects: Common side effects and rare side effects Apart from the beneficial effects this
medication has some side effects. You may or may not observe them. Common side effects
include _____ and some rare but important side effects are _____.
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Management of side effects: These side effects can be managed by ____ E.g. Since, it may cause
constipation, drink about 8-10 glasses of water every day. E.g. Since, it may cause drowsiness,
please do not drive or operate machinery under its influence. E.g. Since, it is hard on the
stomach, make sure you take it with food and avoid alcohol.
Warning for Anaphylaxis: Since you are taking this medication for the first time, if you get hives
all over the body or shortness of breath or swelling of the lips and tongue you may be allergic to
this medication. Stop taking it and immediately go to the emergency department.
Monitoring/when to see a doctor: You should start feeling better in about ____ days. If not,
please contact your doctor.
Self-care measures: Apart from this medication, there are some self-care measures that you can
take to help your condition. ____________________________
Ask if they have any questions or concerns Do you have any questions or concerns?
Follow up with patient Can I give you a call in ________ days to see how you are doing on this
medication?
Additional optional points depending on each station
Disease management and education
Storage
Demonstration of Device
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Brand and Generic names of
top drugs
In this section, you will find a list of some of the very common
medications that you come across in practice. It is recommended that
you orient yourself with these medications and to learn about their
importance.
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Antiepileptic Therapy:
Brand
Generic
Lamictal
Lamotrigine
Dilantin
Phenytoin
Tegretol
Carbamazepine
Migraine Therapy:
BRAND
GENERIC
A MERGE
NARATRIPTAN
IMITREX
S UMATRIPTAN
Z OMIG
Z OLMITRIPTAN
Neuropathic Pain Therapy:
BRAND
GENERIC
L YRICA
P REGABALIN
Antidepressant Therapy:
BRAND
GENERIC
P AXIL
P AROXETINE
P ROZAC
F LUOXETINE
REMERON
M IRTAZAPINE
C IPRALEX
E SCITALOPRAM
C ELEXA
C ITALOPRAM
W ELLBUTRIN
BUPROPION
Antipsychotic Therapy:
BRAND
GENERIC
A BILIFY
A RIPIPRAZOLE
R ISPERDAL
R ISPERIDONE
L ITHIUM
L ITHIUM
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Parkinson’s Therapy:
BRAND
GENERIC
P ROLOPA
L EVODOPA – BENSERAZIDE
Alzheimer’s Therapy:
BRAND
GENERIC
E BIXA
MEMANTINE
REMINYL ER
G ALANTAMINE
Anxiolytic Therapy:
BRAND
GENERIC
V ALIUM
D IAZEPAM
ADHD Therapy:
BRAND
GENERIC
S TRATERRA
A TOMOXETINE
C ONCERTA
METHYLPHENIDATE
R ITALIN
METHYLPHENIDATE
Smoking Cessation Therapy:
BRAND
GENERIC
C HAMPIX
V ARENICLINE
Asthma, COPD and Seasonal Allergy Therapy:
BRAND
GENERIC
P ULMICORT
BUDESONIDE
F LOVENT HFA
F LUTICASONE
V ENTOLIN
S ALBUTAMOL
NASONEX
M OMETASONE
S INGULAIR
M ONTELUKAST
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A DVAIR D ISKUS
S ALMETEROL – F LUTICASONE
O MNARIS
C ICLESONIDE
A TROVENT
I PRATROPIUM
U NIPHYLL
T HEOPHYLLINE
A VAMYS
F LUTICASONE
S YMBICORT
BUDESONIDE – FORMETROL
Antihyperglycemic Therapy:
BRAND
GENERIC
J ANUVIA
S ITAGLIPTIN
G LUCOPHAGE
METFORMIN
A CTOS
P IOGLITAZONE
D IABETA
G LYBURIDE
G LUCA GEN
G LUCAGON
H UMALOG
I NSULIN LISPRO
H UMALIN
I NSULIN NPH
L ANTUS
I NSULIN GLARGINE
L EVEMIR
I NSULIN DETEMIR
Dyslipidemia Therapy:
BRAND
GENERIC
C RESTOR
R OSUVASTATIN
L IPITOR
A TORVASTATIN
Antihypertensive Therapy:
BRAND
GENERIC
L ASIX
F UROSEMIDE
H YDROCHLOROTHIAZIDE
H YDROCHLOROTHIAZIDE
A LTACE
RAMIPRIL
RASILEZ
A LISKIREN
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Antianginal & Cardiotonic Therapy:
BRAND
GENERIC
L ANOXIN
D IGOXIN
N ITRO DUR
N ITROGLYCERIN
N ITROLINGUAL PUMPSPRAY
N ITROGLYCERIN
Anticoagulant Therapy:
BRAND
GENERIC
C OUMADIN
W ARFARIN
P LAVIX
C LOPIDOGREL
Antiemetic Therapy:
BRAND
GENERIC
D ICLECTIN
D OXYLAMINE – PYRIDOXINE
Z OFRAN
O NDANSETRON
METOCLOPRAMIDE
METOCLOPRAMIDE
Peptic Ulcers & GERD Therapy:
BRAND
GENERIC
HP PAC
L ANSOPRAZOLE – C LARITHROMYCIN – AMOXICILLIN
NEXIUM
E SOMEPRAZOLE
IBD &Crohn’s:
BRAND
GENERIC
A SACOL
5-ASA
REMICADE
I NFLIXIMAB
Obesity Therapy:
BRAND
GENERIC
XENICAL
O RLISTAT
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Contraceptives & Hormonal therapy:
BRAND
GENERIC
E VRA
N ORELGESTROMIN - ETHINYL ESTRADIOL
Y AZ
D ROSPIRENONE - ETHINYL ESTRADIOL
S EASONALE
L EVONORGESTREL - ETHINYL ESTRADIOL
E STROGEL
E STRADIOL -17Β
NUVA RING
E TONOGESTREL - ETHINYL ESTRADIOL
A LESSE
L EVONORGESTREL - ETHINYL ESTRADIOL
A NDROGEL
T ESTOSTERONE
P LAN B
L EVONORGESTREL
P REMARIN
C ONJUGATED ESTROGENS
Acne Therapy:
BRAND
GENERIC
A CCUTANE
I SOTRETINOIN
C LINDOXYL
C LINDAMYCIN – BENZOYL PEROXIDE
Osteoporosis Therapy:
BRAND
GENERIC
A CTONEL
R ISEDRONATE
D IDROCAL
E TIDRONATE – CALCIUM CARBONATE
F OSAMAX
A LENDRONATE
E VISTA
RALOXIFENE
BPH Therapy:
BRAND
GENERIC
F LOMAX
T AMSULOSIN
P ROSCAR
F INASTERIDE
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Erectile Dysfunction Therapy:
BRAND
GENERIC
C IALIS
T ADALAFIL
V IAGRA
S ILDENAFIL
Antibacterial, Antiviral & Antifungal:
BRAND
GENERIC
C IPRO / CIPRO XL
C IPROFLOXACIN
A MOXICILLIN
A MOXICILLIN
Z ITHROMAX
A ZITHROMYCIN
BIAXIN / BIAXIN XL
C LARITHROMYCIN
A VELOX
M OXIFLOXACIN
L EVAQUIN
L EVOFLOXACIN
METRONIDAZOLE
METRONIDAZOLE
F UCITHALMIC (VISCOUS EYE DROP )
F USIDIC A CID
C IPRODEX
C IPROFLOXACIN – DEXAMETHASONE
MACRO BID
N ITROFURANTOIN
C LINDAMYCIN
C LINDAMYCIN
T AMIFLU
O SELTAMIVIR
P ENLAC
C ICLOPIROX
N IZORAL
K ETOCONAZOLE
Antimalarial:
BRAND
GENERIC
MEFLOUINE
MEFLOQUINE
MALARONE
A TOVAQUONE
Q UININE
Q UININE
Vitamins and Minerals:
BRAND
GENERIC
S LOW K
P OTASSIUM C HLORIDE
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P ALAFER
F ERROUS FUMARATE
P REGVIT FOLIC 5
MULTIPLE VITAMINS AND MINERALS
Opioids and opioid agonists:
BRAND
GENERIC
D URAGESIC
F ENTANYL
S UBOXONE
BUPRENORPHINE – NALOXONE
RE VIA
NALTREXONE
METADOL
METHADONE
O XY NEO
O XYCODONE
Anorectal& Wart Therapy:
BRAND
GENERIC
A LDARA
IMIQUIMOD
P ROCTOFOAM – HC
H YDROCORTISONE – PRAMOXINE
W ARTEC
P ODOFILOX
HIV Therapy:
BRAND
GENERIC
3TC
L AMIVUDINE
K ALETRA
L OPINAVIR – RITONAVIR
Others:
BRAND
GENERIC
DDAVP MELT
D ESMOPRESSIN
D ETROL LA
T OLTERODINE
C ELLCEPT
MYCOPHENOLATE MOFETIL
METHOTREXATE
METHOTREXATE
P ROPECIA
F INASTERIDE
S ERC
BETAHISTINE
P REDNISONE
P REDNISONE
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P ERIDEX
C HLORHEXIDINE
E PIPEN
E PINEPHRINE
P ATANOL
O LOPATADINE
XALATAN
L ATANOPROST
D UKORAL
O RAL INACTIVATED TRAVELLERS ’ DIARRHEA AND CHOLERA
VACCINE
P ROGRAF
T ACROLIMUS
C ELEBREX
C ELECOXIB
S YNTHROID
L EVOTHYROXIN
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Recent medications that have been added to the Canadian market
Brand
Generic
Class or Uses
Zenhale MDI
Mometasone&Formoterol Long-Acting Beta2Agonist
Vaniqa
Eflornithine
Hair Growth Inhibitor
Dexilant
Dexlansoprazole
Proton Pump Inhibitor
Emend
Aprepitant
Chemotherapy induced
vomiting
Enablex
Darifenacin
Treatment of overactive
bladder
Invega
Paliperidone
Antipsychotic
Inspra
Eplerenone
Aldosterone Antagonist
Olmetec
Olmesartan
Angiotensin Receptor
Blocker
Onglyza
Sexagliptin
Antihyperglycemic agent
Staxyn
Vardenafil
Treatment of erectile
dysfunction
Sublinox
Zolpidem
Hypnotic agent
Vimpat
Lacosamide
Antiepileptic agent
Zeldox
Ziprasidone
Antipsychotic
Zytram XL
Tramadol
Opioid Analgesic
Zyvoxam
Linezolid
Antibacterial
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Scenario / Background Information: Case 1
Patient is coming to pick up new medication. Respond as you would in everyday practice.
Reference: eCPS(Zoloft), Patient profile, Print out of CMTA (Depression)
Patient’s Info:
Opening statement: Can I pick up my medication
Is it for you? Yes. My name is Michelle Snow
Why did you see you Dr : For my low mood
Age: 23-Female Allergy : None
Medications: Rx NONE : Planning to start St John’s worts for faster recovering.
Pregnant: No
Breastfeeding: No
Caffeine:
No Alcohol :
Diet: No good appetite.
No
Smoking: NO
Exercise:
Don’t feel like
Question at 5 minute bell: What happens if I take St. John’s worts?
Mannerism: normal
Special Note:
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XYZ Medical Clinic
Xxxx
Xxx
xxx-xxx-xxxx
Michelle Snow
Xxxx
Rx
Zoloft 25mg (Brand only)
Take 1 capsule every night for 1 week and then If tolerated take
2 capsules every night.
M: 30 days’ supply
Make sure to see me after 1 month; Take appointment now.
Dr. R Tan
PATIENT RECORD
PATIENT: Michelle Snow
ADDRESS: xxxx
PHONE: xxxx
AGE: 24 years old
SEX: Female
ALLERGIES: NKA
COMMENTS: None
PHYSICIAN: Dr. J. Brown
No. Medications - Directions
Q
DR
Auth
Rem
Original Refill
Last
Filled
Zero
53
Today
Zoloft 25mg (Brand only)
1
Take 1 capsule every night for 1 week
and then If tolerated take 2 capsules 53
every night
Dr Tan,R 53
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Zero
Page 24
Ideal Response:








Express empathy: Sorry to hear about your low mood. I will try to help you in this regard.
Rule out pregnancy and breast feeding
Respond to St John wort’s taking for faster recovery: We will talk about this later.
Counsel on Zoloft: With food. 1 cap for 1 week before going to bed and than 2 capsules if no
bothersome side effect.
Effect not right away; several weeks, Physical effect like sleep, appetite and energy level
sooner.
S/E: Dryness of mouth Try sugarless gum, constipation: Include fibre food in diet.
Reduced sexual desire.
Continue taking medication even if you feel well and not to stop any point to prevent
withdrawal effect.
To see Dr ASAP is any S/E bother day to day activity. Any thoughts of harming your self.
Call 911 for severe allergic reaction because first time.
Not to use St John’s wort because of interaction with Zoloft.
Answer 5th minute question: It can lead to Serotonin syndrome: mild (shivering and
diarrhea) to severe (muscle rigidity, fever and seizures). Severe serotonin syndrome can be
fatal if not treated. Checking from CMTA print out.
Convey Dr’s note: To see him after 30 days and book an appointment.
Self-care: Socialising, Joining Gym etc.
Follow up
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Few products with
important instructions
For storage, stability,
priming and shaking etc.
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Active ingredient
Brand name
Store at
2* - 8* C
Ipratropium Nasal Spray
Atrovent Nasal Spray
N
Maximum
days at
room
temp
A
Latanoprost
Xalatan Eye Drops
Y
Latanoprost/Timolol
Xalacom Eye Drops
Trifluridine
Prime
Shake
Indication
N
N
Allergic Rhinitis
6 Weeks
N
N
Glaucoma
Y
10 Weeks
N
N
Glaucoma
Viroptic Eye Drops
Y
30 Days
N
N
Keratoconjunctivitis
Zolmitriptan Nasal Spray
Zomig Nasal Spray
N
A
N
N
Migraine Headache
Sumatriptan Nasal Spray
Imitrex Nasal Spray
N
A
N
N
Calcitonin Salmon Nasal
Spray
Miacalcin Nasal Spray
Y
4 Weeks
(<25 *C)
Y
N
Migraine Headache
Acute pain of vertebral
fracture,
Osteoporosis
Butorphanol Nasal Spray
Stadol Nasal Spray
N
A
Y
N
Xylometazoline Nasal Spray
Otrivin Nasal Spray
Nitroglycerine Nasal
Spray
N
A
Y
N
Y
N
Rhinocort Nasal Spray
N
Y
Y
Allergic Rhinitis
Y
Y
Allergic Rhinitis
Y
Y
Allergic Rhinitis
Budesonide Aqueous Nasal
Spray
Fluticasone propionate
Nasal Spray
Mometasone Nasal Spray
Flonase Aqueous Nasal
Spray
Nasonex Nasal Spray
Traimcinolone Nasal Spray
Levocabastine Nasal Spray
A
Allergic Rhinitis
N
Between
4 to 30 *C
A
Nasacort Nasal Spray
N
A
Y
Y
Allergic Rhinitis
Livostine Nasal Spray
N
A
Y
Y
Allergic Rhinitis
N
Treatment for the symptomatic
Delta-9tetrahydrocannabinol (THC)
- cannabidiol (CBD)
Sativex Buccal Spray
Y
28 Days
Y
Y
Betoxolol
Betoptic S
N
A
N
Y
Ciclesonide
Alvesco
Levocabastine Eye Drops
Livostin Eye Drops
N
Y
Desmopressin Acetate
DDAVP Nasal Solution
Benzamycin Topical Gel
Clindoxyl Gel
DDAVP Nasal Spray
Benzyl Peroxide/
Erythromycin
Clindamycin gel
Y
relief of neuropathic pain in
Multiple sclerosis in adults.
Glaucoma
Stop if no improvement seen
in 3 days, discard after one
month
Enuresis
A
y
Enuresis
Y
Y
Acne
Acne. After Dispensing write 3
© Copyright SolRx Inc. 2016 www.solrx.ca e-mail: [email protected] 1-888-267-2464
months expiry months
Page 28
NMOS = No More Shaking but requires PRIMING:
N = Nitroglycerine
M = Miacalcin Nasal Spray
O = Otrivin Nasal Spray
S = Butorphenol (Stodol) Nasal Spray
Medication where the SHELL comes out in Stool

CONCERTA

ASACOL (5 ASA)

SLOW K

ADALAT (NIFEDIPINE XL)

DETROPAN XL (OXYBUTININ)
DRUGS TO BE TAKEN ON AN EMPTY STOMACH
GASTRO INTESTINAL
CARDIOVASCULAR

Lansoprazole (PPI)

Captopril (1hr before preferred)

Sucralfate (1h before)

Perindopril

5-Aminosalicylic acid

Cholestyamine

Domperidone

Dialtiazem regular

Metoclopramide

Dipyridamole (1h before)

Mineral oil (2h before)

Gemfibrozil (30 mins before)

Bisacodyl

Isosorbide Dinitrate regular

Phosphates Solution

Sotalol (1-2 h before)
© Copyright SolRx Inc. 2016 www.solrx.ca e-mail: [email protected] 1-888-267-2464
Page 29
ANTIINFECTIVE
ANTI-RETROVIRAL

Ampicillin

Didanosine (30 mins before or 2 hr after)

Cloxacillin

Imprenavir

Chloramphenicol

Efavirenz

Efavirenz

Didanosine — EC
VACCINES

Norfloxacin

Cholera vaccine (1hr before & after)

Itraconozole liquid

Typhoid vaccine (1 hr before)

Metronidazole ER

Demiclocycline
CNS

Tetracycline

Zalepelon, Diethylpropion (1h before) used in
obesity
MUSCULOSKELTAL

Miscellaneous

Alendronate (30 mins before)

Mycophenolate tabs/caps/liquid (in organ

Etidronate (2h before or after) at night

Risedronate (30mins before)
transplantation)

Phosphate solution

Bethanechol (for urinary retention)
DIABETES

Nateglinide (1min before meal)

Tolbutamide

Repaglinide
ASTHMA

Sodium Cromoglycate

Zafirlukast

Budesonide

Aminophylline
© Copyright SolRx Inc. 2016 www.solrx.ca e-mail: [email protected] 1-888-267-2464
Page 30
Important to know
Empty Stomach = 1 h before or 2 h after meals with a full glass of liquid, usually water
Before Meals = Usually 15 to 30 min before meals
Empty Stomach Preferably = May be taken with food if gastric upset occurs
With or Without Food = May be given without regard to meals
WITH LOTS OF WATER

Allopurinol

Bisphosphonates

Bisacodyl

Metamucil

Docusate sodium/calcium

Cyclophosphamide (x HS – sit in bladder too long)

Efavirenz (avoid high fat meal)

Indinavir

Lithium(prevent dehydratation)

Fluoroquinolones

Theophylline

Tetracycline

TMP/SMX

Sulphonamides

Clindamycin to prevent oesophageal ulcer

Probenacid
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Special Instructions: How to take medication (Adopted from CPS)

Alpha-D-Galactosidase: Swallow, chew or crumble onto food; add only to food cool enough to eat

Amiloride: Food decreases GI side effects; avoid large quantities of potassium-rich foods

Buprenorphine/Naloxone: Sublingual. Place under tongue until dissolved; takes 5 to 10 minutes for
the tablet to dissolve; do not swallow

Captopril: 1 h before meals preferred; may take with food but be consistent

Carvedilol: Food slows rate of absorption and incidence of orthostatic effects especially during
dose titration; take with a glass of water

Cefuroxime Axetil suspension: Food increases absorption; may add to cold milk, lemonade, and
apple, orange or grape juice before administration, drink immediately

Chloral Hydrate: Dilute with 120 mL of water or other liquid, e.g., fruit juice, to reduce gastric
irritation

Chlordiazepoxide/Clidinium: 30 to 60 min before meals to maximize absorption

Cholera Vaccine and Traveler’s Diarrhea — Inactivated: Avoid food and drinks 1 hour before and
after vaccine administration; vaccine is acid labile. Dissolve supplied effervescent granules of
sodium hydrogen carbonate buffer in a glass of water (~150 mL). Mix vaccine with sodium
hydrogen carbonate solution and drink the mixture within 2 hours. Can also store mixture at room
temperature (<27°C) for up to 2 hours

Cholestyramine: Mix with water, milk, fruit juice or other noncarbonated beverage; may also be
mixed with highly fluid soups or pulpy fruits with high moisture content, e.g., applesauce, crushed
pineapple

Colestipol - granule : Add to water, milk, flavored drink, juice, carbonated beverage or any other
liquid; may also add to hot or cold cereals, soups (avoid chunky soups), yogurt, pudding, cottage
cheese or pulpy fruits, e.g., crushed pineapple, pears

Digoxin: Meals high in bran fiber may reduce amount of drug absorbed

Docusate Sodium - drops/syrup: Dilute with milk, fruit juice or infant formula to mask bitter taste

Doxycycline: Food decreases GI side effects; with a glass of water to avoid esophageal ulceration.
Avoid concomitant use of milk, antacids or drugs containing aluminum, calcium, magnesium or iron
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
Esomeprazole: With a glass of water; may disperse in 120 mL of non-carbonated water — no other
liquids should be used as the enteric coating may be dissolved, stir until tablet disintegrates, drink
the liquid with the pellets within 30 minutes, rinse the glass with 120 mL of water and drink; the
pellets must not be crushed or chewed

Felodipine: With a glass of water; avoid meals rich in carbohydrate or fat — significant increase in
Cmax

Finasteride: Crushed or broken tablets should not be handled by women who are or may become
pregnant

Hydromorphone SR: Swallow whole; may sprinkle contents of capsule onto soft food but do not
chew the beads

Hydroxyurea: With a glass of water; may empty contents of capsule into a glass of water and take
immediately. Do not allow powder onto hands and do not inhale powder

Iron Salts - capsules/tablets: Food, especially dairy products, coffee and tea, decreases absorption
and GI side effects

Iron Salts - liquid: Dilute dose with water or juice (not milk)

Itraconazole - capsules: Swallow whole; with cola beverage if achlorhydria or on acid secretion
suppressor.

Itraconazole - liquid: Swish and swallow; do not rinse after swallowing. Not with grapefruit juice;
see also Drug Administration and Grapefruit Juice section in Clin-Info

Ketoconazole: With cola beverage if achlorhydria or on acid secretion suppressor

Lansoprazole - capsules, delayed release: Before breakfast and/or meals; with a glass of water;
swallow whole; delayed-release capsules can be opened and the intact granules can be sprinkled
on a tablespoon of applesauce and swallowed immediately; do not chew or crush granules;
granules can also be mixed in juice for nasogastric administration (stable for up to 30 min)

Levodopa/Carbidopa - CR: 200/50 strength tablets may be halved

Levothyroxine: Be consistent; can be crushed and suspended in water or mixed with soft food, e.g.,
applesauce; however, do not use foods with a large amount of soybean, fiber or iron for
administration

Linezolid: Avoid foods or beverages with high tyramine content
© Copyright SolRx Inc. 2016 www.solrx.ca e-mail: [email protected] 1-888-267-246433

Metformin - ER: Must be taken with food — optimizes absorption and ensures complete release of
metformin

Montelukast Sodium - granules: Can be taken directly by mouth. May mix granules with a spoonful
of cold or room temperature food, e.g., applesauce; do not chew granules

Morphine - SR: With a glass of water; only 200 mg SR tablet (MS Contin) may be halved along
scored line; may open SR capsule and sprinkle contents onto soft food, e.g., applesauce; do not
chew the pellets

Nicoumalone (Acenocoumarol): Be consistent; avoid abrupt changes in diet to maintain constant
vitamin K intake

Nimodipine: If patient cannot swallow capsule, contents may be aspirated into syringe, emptied
into patient's naso-gastric tube and washed down tube with 30 mL normal saline

Nystatin: Sparingly absorbed

Pancreatic Enzymes - capsules with EC granules: With each meal or snack; with a glass of water;
swallow whole; may open capsule and sprinkle onto soft food, e.g., applesauce, do not chew
granules, take immediately after sprinkling

Potassium Salts - SR capsules: With a glass of water; swallow whole; may sprinkle contents of
capsule onto soft food, e.g., applesauce, and swallow without chewing

Potassium Salts - SR tablets: With a glass of water; may break tablet in half for K-Dur; may also
disintegrate tablet in half glass of water, stir and swallow immediately, rinse any residue on glass
with more water and swallow

Psyllium - powder: With meals for cholesterol-lowering effect; mix dose into water, juice or other
suitable liquid; follow dose with additional glass of liquid

Theophylline - Uniphyl: With or shortly after evening meal; with a glass of water; tablet may be
halved

Topiramate - capsules: Swallow whole; may sprinkle contents of capsule onto soft food, e.g.,
applesauce, swallow without chewing
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Common side effects and their management

Retinoids - Photosensitivity : Use sunscreen higher than SPF 30
Chapping of lips and dry skin: Use emollient and lip balm

Triptans - Flushing, bad after taste, Nausea, vomiting
Dizziness: Do not operate heavy machinery or task that require attention

ACE I - Hypotension: Do not change the posture abruptly
Headache: take 1-2 tabs Tylenol if needed. Except: RPS

Champix (Varenicline) - Constipation: Drink minimum of 8 glasses of water
Other GI side effects like nausea vomiting- take with food.

Detrol LA (Tolterodine) - Dry mouth, suck on ice chips, sugarless candies, or chew gum
GI side effects- with food

Flomax (Tamsulosin) - GI side effects – Take with food
Nasal congestion- use steam, Vicks vaporub, and nasal saline.
Rhinitis - Drink lukewarm water; speak to your doctor if bothersome
Headache- take with 1-2 tab of Tylenol if needed

Lamictal (Lamotrigine) – Headache - Take with 1-2 tabs of Tylenol if needed
Drowsiness, dizziness- do not operate heavy machinery or drive

3TC (Lamivudine) - GI side effects- with food
Constipation - Lots of fibres and 8 glasses of water
© Copyright SolRx Inc. 2016 www.solrx.ca e-mail: [email protected] 1-888-267-246435

Lyrica (Pregabalin) - Weight gain - Consult a dietician and exercise
Dry mouth, suck on ice chips, sugarless candies, or chew gum
Drowsiness, dizziness - Do not operate heavy machinery or drive
Constipation - Lots of fibre and 8 glasses of water

Methotrexate - Mouth ulcer: Ask your Dr for folic acid Rx
Photosensitivity – sunscreen higher than SPF 30 and protective clothing
Nausea, vomiting- with food. If bothersome speak to your doctor. Use Gravol
ORS and electrolyte drinks like gastrolyte, or ginger cubes

Plavix (Clopidogrel) - Dizziness - Do not operate heavy machinery or drive
Bleeding - Don’t do any activities where there is chance for cut or fall

Premarin (Conjugated estrogens) - Weight gain - Consult a dietician and exercise
Nausea, vomiting – Take with food
Headache - Take 1-2 tabs Tylenol if needed
Mood changes - Get involved in activities that elevate your mood

Proscar (Finasteride) - Runny nose - Keep tissues handy, if bothersome, visit us or doctor
Dizziness - Don't drive or operate heavy machinery until you are adjusted to the drug
Postural hypotension - Change your posture slowly

Remeron (Mirtazepine) - Dry mouth - Chew gum, sugar free candies, frequent sips of water
Weight gain and increased appetite - Include exercise in your daily routine, increase sleep

Prograf (Tacrolimus) – Headache - If not bearable take Tylenol
Insomnia, increased glucose levels - Keep your regular doctor’s appointment
Avoid grape fruit juice to prevent increased risk of side effects.
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
Risperdal (Risperidone) – Nausea - Take with food
Tremors and difficulty in movement - Could subside with continuous use

Slow K – Nausea, vomiting, stomach upset - Take it after meals

Xenical (Orlistat) - Bloating, flatulence and oily spotting – Take with or after meals
Increased risk of infection - Yogurt and probiotics (No fat meal - Skip dose)

Zofran (ondansetron)- decrease heart rate, headache, increase LFT keep your lab appointments
(for chronic use only) some stomach upset

SSRIs - Nausea, loss of appetite, weight loss – Maintain a healthy diet with frequent small meals
Sleep disorder - Start in the morning if you feel tired or sleepy switch to bed time

ISDN – Headache - 1-2 tablets of Tylenol however it’s usually transient
Flushing, increased risk of falls - Take it while sitting and change your posture slowly

Antimalarial - Sun sensitivity - Use sunscreen, if any change in vision, contact doctor
Stomach upset - Take with food
Mefloquine could be taken with a glass of milk.

Macrobid - Urine discolouration, transient headache, loss of appetite
Nausea - Take with food

Xalatan (Latanoprost) - Change of eye color, stinging and discomfort, increase in eyelash length

B-blockers - Dizziness ,fatigue - Do not operate machines or drive until you adjust to it
Increased risk of falls - Change posture slowly
Fluctuated glucose levels - Keep regular lab appointments
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
B-agonist - Heart racing, headache – usually transient, can take Tylenol
Dizziness – Change posture slowly

Estrogen – Nausea, vomiting - Take with food,
Breast tenderness - Self-examine breasts for lumps
Weight gain - Include exercise in your daily routine
Spotting is possible, if you experience ACHES stop using the medicine

Corticosteroids - Oral thrush - gargle after inhalation / swallowing
May deplete calcium - Take calcium and vitamin D
Increased risk of infection - Use probiotics or yogurt

NSAIDs - Acidity, heartburn - Take with food.

Statins - Avoid grape fruit juice except RPS
Dizziness – Change posture slowly
Mild nausea – Take with food

Opioids - Constipation - 8-10 glass of water
Nausea – Take with food
Drowsiness – Caution when driving or operating machinery
Causes dependence and tolerance.
**Exercise: Complete the rest of the most common prescription
list of drugs on your own using the above format as a guide. **
© Copyright SolRx Inc. 2016 www.solrx.ca e-mail: [email protected] 1-888-267-246438
OTC recommendations
© Copyright SolRx Inc. 2016 www.solrx.ca e-mail: [email protected] 1-888-267-246439
Communication: The literal meaning of communication is an INTERCHANGE of thoughts, opinions or
information by speech, writing or signs.
• 38% of your score will be based on your communication for OSCE exam.
• OSCE is NOT only about your knowledge, but about the application of knowledge in health care
setting to ensure complete patient care through an interaction.
• Interactions require communication: written and/or verbal.
So what is communication in relevance to OSCE?
The ‘TOTAL’ presentation you deliver in your interaction with the patient or other healthcare
providers.
VERBAL
It’s all about what you say and how you say it.
Speaking: It’s very important to pay special attention, when you communicate with your patients.
Sometimes your gestures you think as normal could be extremely offensive, or simply wrong, and vice
versa. Choose your words carefully as blurting out wrong words can simply cause you trouble or
unnecessary embarrassment.
Example 1: Choice of words may HARM the patient?
While counseling for Prozac 20 mg:
Pharmacist: “Your doctor prescribed you this medication to treat your DEPRESSION”
Patient: “I DO NOT HAVE DEPRESSION. I ONLY HAVE LOW MOOD. I AM NOT GOING TO TAKE THIS
MEDICATION!!!”
Here, the pharmacist should have started by asking why the doctor prescribed the medication.
Example 2: While counseling for ACE inhibitor:
Pharmacist: “Your doctor has prescribed you this medication for hypertension”
Patient: STARTS USING THE MEDICATION WHEN HE FEELS STRESSED OUT OR WHEN HE HAS
TENSION.
The Pharmacist should have used simple layman language. “High Blood Pressure Medication”
instead of “Hypertension”
© Copyright SolRx Inc. 2016 www.solrx.ca e-mail: [email protected] 1-888-267-246440
Key points you need to keep in mind while speaking:
O
Be loud and clear
o Use layman language with patient
o Use medical language with health care provider
o Be precise, do not be repetitive
o BE CONFIDENT!
Listening: It is a key component to SUCCESSFULLY passing each individual station.
Pay special attention to the opening statement – it will give you the THEME/ JIST of the individual
station.
If you did not hear the first time, ask politely to repeat and DO NOT make assumptions!
NON-VERBAL
It’s about delivering a message without talking. It depends basically on your gesture, body language,
look and the way you approach situations.
o Posture and Mannerisms
o Personal space (Maintain at 5-7 meter distance)
o Facial expression - Being pleasant excited, or sympathetic as per the condition
o Eye contact
Empathy
The intellectual identification of feelings, thoughts, or attitudes of another person’s experience OR the
ability to put oneself in other person’s shoes.
It has to be GENUINE AND APPROPRIATE.
Do not say that you “UNDERSTAND” instead use words like “APPRECIATE” or “IMAGINE”
Example 1: A patient comes into the pharmacy complaining about pain
“I can see that it is really bothering you”
“I will definitely try to help to relieve your pain”
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“I will surely help you with that”
Example 2 : A patient comes in complaining about lack of sleep
“I can see that you look tired today”, “It must be hard for you”
“I hope this medication gives you the restful sleep you deserve”
Less is more: In communication, less is more. Listening is as important part of communication as
speaking. Even while you speak, remind yourself to be as precise as possible. Do not keep repeating
yourself.
Open ended versus Closed ended Questions: Both type of questions have their importance. Usual way
of starting communication is to ask open ended questions to gather information and then follow up
with Closed ended question to come to a conclusion.
Example: Patient comes in for recommendation on cough and cold
You start with open ended questions: “Tell me more about your problem.”
“What else should I know? Is there anything else that I should know of?”
After basic information gathering, you can quickly reach a conclusion by asking Closed ended
questions like:” Any fever? Any form of allergies?”
Following the Template: It is important to follow a template to ensure your success in the exam. The
template allows you to gather all relevant information quickly and completely. It also allows you to
communicate in an organized way in interactive stations.
The template allows you to:
o Not to miss out on important points supplied by the patient
o Avoid repeating your questions
o Stay organized
o Stay focused
You will find out more about templates in the coming chapter. It takes a lot of practice to be able to
deliver what you mean and how you want the patient to understand it.
Also stay alert, because it is an art to pick up on verbal and non-verbal clues from the patient.
© Copyright SolRx Inc. 2016 www.solrx.ca e-mail: [email protected] 1-888-267-246442
Detailed template for OTC stations
INTRODUCTION
Introduce yourself: Hello! My name is _____ I am the pharmacist on duty today. How may I help you?
Identify the Patient: Is it for yourself? (Depending on what patient /actor says)
Offer privacy and confidentiality: To ensure that I make an appropriate recommendation, I need to ask
you few questions. Is that okay with you? Please be seated in our private counseling area and whatever
we discuss will be confidential. Please feel free to ask me any questions you may have
INFORMATION GATHERING
MEDICAL INFORMATION: Symptoms and Red Flags Can you please tells me the symptoms in detail?
What else? Ask quantity, severity etc.?
E.g.: How many vomits? Since when did it start etc. on a pain scale of 1-10 with 10 being most
unbearable, where would you rate your pain?)
Rule out red flags
Is there anything else you would like to share?
3 essential questions
Did you speak to your doctor about this condition? If yes, what did he advice?
Is it the first time you are experiencing this symptoms? If no, how did you manage it before?
Have you tried any medication for it before coming to pharmacy?
Medical Conditions: Do you have any medical conditions that I should know? Besides this, do you have
any other medical condition? (Continue till patient runs out of all his conditions) Are all you medical
condition under control?
Allergies, Severity of allergy: Do you have any known drug allergies? Any environmental or food
allergies? (If yes) So what happened when you got the allergic reaction? (Distinguish between true
allergy and sensitivity/side effect)
© Copyright SolRx Inc. 2016 www.solrx.ca e-mail: [email protected] 1-888-267-246443
Rx Medications: Are you taking any prescription medications? (If yes) How are you doing with them?
(Continue until they run out of medications)
Herbal, OTC Medications: Are you taking any over the counter medications likes Tylenol or Advil? Are
you taking any herbals, vitamins or mineral supplements?
Pregnancy and breastfeeding if women 18 -48: Some medications may not be indicated in pregnancy or
breastfeeding. So, can you let me know if you are pregnant or breastfeeding
SOCIAL HABITS AND LIFESTYLE INFORMATION
[Ask patient permission if you can ask them questions about their lifestyle]
Sometimes, our lifestyle may affect the disease and the way medications work. May I ask you a few
questions about your lifestyle?
Caffeine: Do you consume caffeinated beverages like coffee, tea or cola? (If yes) May I ask how many
per day?
Alcohol: Do you consume alcohol? If yes, how many drinks per week?
Smoking: How about smoking? How many packs per day?
Exercise: Do you find time to exercise regularly?
Diet: How would you describe your diet?
(If the patient’s lifestyle is good and healthy, it is a good idea to appreciate it)
CHECKING REFERENCE
Ask permission to look at reference and get back to the patient is it okay, if I check my reference and
come back to you?
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COUNSELING
Offer choice if available; tablet, liquid, different flavours. Also ask if you have any product in mind.
Drug: brand name, generic name, strength, dosage and duration of treatment I am recommending you
(Brand name) which contains (Generic name) in the strength of _____. You need to take (dosage e.g.
one tablet once a day at roughly the same time everyday): Continue taking this medication for ____
days
With or without food This medication is best taken before/after food (Give reason).OR, you can take
this medication with or without food, either ways it works fine.
Purpose of medication, how it works and onset This medication is for _____________. It works by
_______ and thereby controls/helps with _________. It will provide immediate effect OR, It may take
some time up to _____before you can see the effect. It must be taken every day for it to be effective. It
should be taken as and when needed
Side effects: Common side effects and rare side effects Apart from the beneficial effects this
medication has some side effects. You may or may not experience them. Common side effects include
_____ and some rare but important for you to be aware of are _____
Management of side effects: These side effects can be managed by ____
Eg1: Since it may cause constipation, drink about 8-10 glasses of water every day
Eg2: Since it may cause drowsiness, please do not drive or operate machinery under its influence
Eg3: Since it is hard on the stomach, make sure you take it with food and avoid alcohol
Warning for Anaphylaxis: Since you are taking this medication for the first time, if you experience hives
all over the body or shortness of breath or swelling of the lips and tongue you may be allergic to this
medication. Stop taking it and immediately go to the emergency department
Monitoring/when to see a doctor: Mention monitoring parameter and when to contact your doctor
Eg1: In case of fever; if the fever goes above 40.5 c or does not come down in 24 hours or does not go
away in 3 days then make sure you see your doctor
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Self-care measures: Apart from this medication, there are some self-care measures that you can
perform to help with your condition ________
Ask if they have any questions or concerns: Do you have any questions or concerns?
Follow up with patient: Can I give you a call in ________ days to see how you are doing on this
medication?
Additional optional points depending on each station
Disease management and education
Storage
Demonstration of Device
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Brand and Generic names of
most commonly used OTC drugs
The following is a list of over the counter medications that you need to
be aware of. They are scheduled according to different medical
conditions where they can be recommended. Also, study the common
things to keep in mind for each group.
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Cold & Flu
Generic Name
Brand Name
Acetaminophen 80mg/ml
Tempra drops (Infants)
Acetaminophen 160/ml
Tylenol Susp. (2-11 years)
Ibuprofen 100/5ml
Advil Susp. (2-12 years)
Dextromethorphan &Guaifenesin
Robitussin DM
Others
Benylin, Buckley’s, Neocitran, Nyquil, Tylenol, Advil*
Keep in mind:






Do not recommend NSAIDs to patients with high blood pressure
Accurate dose is usually derived based on weight rather than age
Advil (NSAID) is usually taken with food to reduce any gastric irritation
NSAIDs are to be avoided in children with asthma
Aspirin is not recommended for the treatment of fever in children
Self-care measures include: Drinking plenty of fluids, rest and avoid exertion. Also try to
avoid over bundling the child with too many clothes
Nasal Congestion†
Generic Name
Brand Name
Pseudoephedrine 30mg
Sudafed
Cromolyn Sodium
Rhinaris CS
Oxymetazoline
Dristan, Drixoral, Otrivin
Saline
Otrivin. Salinex, Rhinaris
Loratidine
Claritin Nasal Pump
Keep in mind:
 Pseudoephedrine should be avoided in hypertensive and diabetic patient. It should not be
taken in pregnancy
 Some nasal decongestants should not be used beyond few days to avoid rebound nasal
congestion
 Self-care measure include: Using inhalation steam and using saline water drops for clearing
the nasal passage
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Allergy medications
Generic Name
Brand Name
Loratadine
Claritin
Desloratidine
Aerius
Diphenhydramine
Benadryl
Chlorpheniramine
Tripolon
Fexofenadine
Allegra
Diphenhydramine Cr.
Benadryl Cr.
Hydrocortisone Cr. 1%
Hydrocortisone Cr.
Keep in mind:
 Desloratidine has anti-allergic and decongestant properties
 Loratadine, desloratadine, cetirizine have non-drowsy properties
 Benadryl, chlorpheniramine have drowsy properties and should be avoided where alertness is
required e.g. Taxi driver
 Self-care measures include – Avoiding allergens and maintaining a diary to identify trends and
irritants
Eyes and Ears Drops
Generic Name
Brand Name
Polymyxin B + Gramicidin
Polysporin Eye/Ear Drops
Polymyxin B + Bacitracin
Polysporin Ophthalmic Ointment
Sodium Cromoglycate
Opticrom Eye Drops
Arachis oil
Cerumol (Removal of ear wax)
Antipyrine + Benzocaine
Auralgan (Ear Ache)
Keep in mind:
 Stinging and burning on the eyes upon application of eye drops is common, and doesn’t
indicate the level of effectiveness of the eye drops.
 For ear wax removal, patient can also use vegetable oils that will result in clearing the
auditory canal.
 Self-care measures for the eye include; apply the drops to both eyes as spreading of the
infection to the other eye is very common, avoid rubbing the eyes and use aseptic
technique while applying the drops
 Self-care measures for the ears; avoid using Q-tips or inserting any objects into the ear to
clean it as this may result in damaging the ears
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Cold Sores
Generic Name
Brand Name
Docosanol
Abreva
Hemorrhoids
Zinc sulfate 0.5%
Anusol Ointment
Pramoxine 1% + Zinc sulfate 0.5%
Anusol Plus
Shark liver oil 3%
Preparation H
Keep in mind:
 Self-care measures include - Empty your bowels before applying the medication to
maximize the contact time, avoid prolonged sitting on the toilet seat
 Avoid spicy food as it may irritate the piles
Constipation
Generic Name
Brand Name
Sodium Picosulfate + Citric acid + Magnesium Sulfate
Pico-Salax
Bisacodyl
Dulcolax
Sennosides
SenoKot
Sennosides + Docusate sodium
SenoKot-S
Docusate Sodium/Calcium
Stool Softener
Glycerin Suppositories
Glycerin Suppositories
Sodium phosphate solution
Fleet Enema
Mineral oil
Fleet Enema (Mineral oil)
15 gm of Magnesium citrate per 300 ml
Citro Mag
PEG 3350
RestroLax
Psyllium
Metamucil
Keep in mind:
 Metamucil is safe to use in pregnancy to treat constipation
 Self-care measures include - Drinking plenty of fluids, adding fibers to diet and being
physically active
 Opioids like Tylenol#3 can cause constipation. Metamucil should not be recommended for
opioid related constipation
 Use of suppository or enema can help empty the bowel quickly while takes longer for
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Metamucil to work
Diarrhea
Generic Name
Brand Name
Loperamide 2 mg tablet or Liquid 2mg/15ml
Imodium
Bismuth Subsalicylate
Pepto-Bismol
Attapulgite suspension
Kaopectate
Oral rehydration solution
Gastrolyte (adults) Pedialyte (pediatric)
Probiotics
Probiotics
Keep in mind:




Imodium (Loperamide) is not recommended in children less than 12 years
Avoid Pepto-Bismol in children under 14 years old with fever (Reye’s syndrome)
Avoid Pepto-Bismol in individuals allergic to aspirin
Oral rehydration therapy is recommended in diarrhea to avoid dehydration. For children,
Pedialyte can be recommended. Gastrolyte is recommended for adults. Gatorade G30 can
be also be recommended
 Kaopectate can be recommended in children
 For Traveler’s Diarrhea: Use of bottled water is recommended. Avoid eating raw food.
Always remember: peel it, boil it, cook it or forget it.
 Pepto-Bismol can be use both as prophylaxis as well as treatment for Traveler’s Diarrhea
Nausea, Vomiting & Motion Sickness
Generic Name
Brand Name
Dimenhydrinate
Gravol (Pink Pack)
Ginger
Gravol (Green Pack)
Scopolamine
Transderm V
Keep in mind:
 Ginger is a non-drowsy option for people who need to avoid drowsiness
 Gravol is given to children less than 2 years and in pregnancy on advice of physician
 Transderm V is not recommended to use more than 6 days in total and each patch no more
than 3 days
 Oral rehydration therapy is an important self-care measure to prevent any dehydration
 Gravol (dimenhydrinate) has potential for abuse. Watch out for customers asking for large
quantity.
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Heartburn
Generic Name
Brand Name
Ranitidine
Zantac
Famotidine
Pepcid
Chewable Calcium Carbonate
Tums
Aluminum Hydroxide and Magnesium Carbonate
Gaviscon
Magnesium Hydroxide and Aluminum Hydroxide
Maalox
Bismuth Subsalicylate
Pepto-Bismol
Aspirin + Sodium bicarbonate + Citric acid
Alka-Seltzer
Sodium bicarbonate + Citric acid
Eno
Magnesium hydroxide
Philips Milk of Magnesia
Keep in mind:




Avoid Bismuth subsalicylate in individuals <18 years old, or those allergic to aspirin
Tums - Safe in pregnancy
Common irritants include: smoking, alcohol and large & heavy meals
Self-care measures include - Avoiding irritants, having smaller meals, avoid meals late at
night, elevating head of the bed
Gas
Generic Name
Brand Name
Simithicone
Ovol/Gas-X/Phazyme
Keep in mind:
 Gripe water comes in 2 forms: one is alcohol free – recommended for children and infants
 Avoid talking while eating food. This may help with gas problem
Emergency Contraceptive
Generic Name
Levonorgestrel
Brand Name
Plan B (Morning after pill)
Keep in mind:
 Now schedule 3 – i.e. available over the counter previously sold as schedule 2 drug
 Time sensitive: effectiveness depends on how soon you take after unprotected intercourse.
Maximum effectiveness is within first 24 hours and can be used up to 72 hours, but
effectiveness decreases.
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Premenstrual Syndrome (PMS)
Generic Name
Brand Name
Acetaminophen
Tylenol
Ibuprofen
Advil/Motrin/Midol
Vaginal Yeast Infection
Generic Name
Brand Name
Fluconazole (one tablet)
Diflucan One
Clotrimazole 500 mg tablet or 10% cream
Canesten 1
Clotrimazole 200 mg ovule or 2% cream
Canesten 3
Clotrimazole 1% cream
Canesten 6
Miconazole 1200 mg ovule
Monistat 1
Miconazole 400 mg ovule
Monistat 3
Miconazole 100 mg ovules
Monistat 7
Keep in mind:
 Fluconazole 150 mg is now available as OTC product (Diflucan One)
 1 day, 3 days or 6/7 days treatment in Canesten or Monistat – the time it takes to resolve
the symptoms is the same but different dosing regimens offers convenience
 Self-care measures include wearing cotton undergarments, maintaining balanced diet and
avoiding tight clothing
Back Pain
Generic Name
Brand Name
Methocarbamol + Ibuprofen
Robax Platinum
Methocarbamol + Acetaminophen
Methocarbamol + Acetylsalicylic acid
Robaxacet
Robaxisal
Keep in mind:
 Methocarbamol is a muscle relaxant and known to cause drowsiness
 Robaxacet is a better option for people with heartburn or sensitive stomach
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Nicotine replacement therapy
Generic Name
Brand Name
Gums
Nicorette gum
Inhaler
Nicorette Inhaler
Patches
Nicoderm
Patch + Gum
Combo Quit
Puffer
Quick Mist
Keep in mind:




It is common to fail and may take multiple attempts before people can succeed in quitting
Patches are available as Step 1, 2 and 3
Gums are available as 2mg and 4 mg
Things that can help increase chances of success: setting a quit date, quit on relatively stress
free days and remove smoking paraphernalia like ashtray that will remind you of smoking
 Also when there is craving – direct your attention somewhere else. Drink water, do physical
activity etc.
Acne
Generic Name
Brand Name
Benzoyl Peroxide
Benzagel (2.5% / 5%)
Keep in mind:
 Self-care measures include - Avoid using oil base cosmetics, avoid squeezing the pimples
and avoid using harsh soaps
Dandruff and Hair Fall
Generic Name
Brand Name
Selenium Sulfate 2.5%
Selsun Blue
Ketoconazole 2%
Nizoral
Minoxidil 2%
Rogaine
Lice treatment
Generic Name
Brand Name
Permethrin
Nix
Piperonylbutoxide + Pyrethrins topical
R&C
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Isopropyl Myristate
Resultz
Keep in mind:
 Avoid recommending Nix or R&C in patients with chrysanthemum or rag weed allergy
 Nix can be recommended for children starting 2 months
 Self-care measures include - Washing washable items in hot water, non-washable items
need to be stored for 2 weeks in sealed bags and using a towel soaked in vinegar and
placing it on top of the hair for 30 minutes will facilitate nits removal
Athlete’s Foot
Generic Name
Brand Name
Tolnaftate 1%
Tinactin (Powder spray / Cream)
Clotrimazole
Canesten
Miconazole 2%
Micatin
Plantar Warts
Generic Name
Brand Name
Topical Salicylic acid for warts (liquid)
Duo film
Keep in mind:
 Avoid touching healthy skin during application
 Self-care measures include - Soak foot in water for 5 minutes and remove dead skin using
pumice stone, always put on foot wear and avoid walking bare foot in public areas
Insomnia
Generic Name
Brand Name
Diphenhydramine 25mg
Sleep Eze
Diphenhydramine 50mg
Nytol, Unisom
Keep in mind:
 Sleep aids are not recommended for use for more than 14 days a month
 If the patient needs sleep aids for more than 10 consecutive nights, then they will need to see
their doctor
 Advice patient about sleep hygiene. (Sleep in a dark sound proof room, avoid physical exercise
before going to bed, avoid caffeine and nicotine before going to bed)
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CNS Stimulant
Generic Name
Brand Name
Caffeine 200mg
Wake up
Iron Supplement
Generic Name
Brand Name
Ferrous Fumarate
Palafer, Eurofer
Polysaccharide iron complex
Feramax 150
Topical Anesthetic
Generic Name
Brand Name
Lidocaine 2.5% + Prilocaine 2.5%
EMLA Cr.
*Those products come in a huge variety and pack size according to indication. Please take a moment to check them online
or in the closest pharmacy to you.
†Check the pack for those products carefully before dispensing. Same brand name can be either normal saline or an actual
medication.
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Scenario / Background Information: Case 20:
Person is coming for OTC recommendation. Respond as you would in everyday practice.
Reference: Print out from CMTC (Fever algorithm and Patient’s Information), Patient profile
Patient’s Info:
Opening statement: What do you recommend for fever
Is it for you? No. For my daughter Julia Sanders
First time: yes, Did you see your Dr; No, Did you try anything : No
Can you describe symptoms in detail: Since yesterday Julia is running a fever and not going down till
morning
Upon asking: Age: 5 years: Weight : 44 LBS
No other symptoms : Everything : No
Did you measure temp: Yes : two times : Yesterday and today morning: Same : 39.5
Allergy : None
Medications : Rx NONE
OTC : None
Pregnant: NA
Caffeine:
Breastfeeding: NA
NA Alcohol :
NA
Smoking: NA
Playful: Yes: active
Diet: Healthy
Question at 5th minute bell: What can happen if fever is not controlled?
Mannerism: normal
Special Note:
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PATIENT RECORD
PATIENT: Julia Sanders
ADDRESS: xxxx
PHONE: xxxx
AGE: 5 years old
SEX: Female
ALLERGIES: NKA
COMMENTS: None
PHYSICIAN: Dr. J. Brown
No. Medications - Directions
Q
DR
Auth
Rem
Original Refill
Last
Filled
Ideal Response









Empathy: Sorry to hear about Julia’s fever: It must be hard for you. I will try to help you
Initially ask open ended questions for symptoms and not going through her profile
Closed ended questions for fever (Without checking reference): Stiff neck, cough, recent traveling,
any dental procedure, vaccination, ear pain
Check reference: ask any other questions remaining
Recommend Tylenol: Ask for flavour choice (2 on table). Also ask Julia’s between chewable tablet
and liquid. Show chart on package and give according to weight and not age. Complete counseling
for Tylenol: Dose, every 4-6 hours, max 5 times daily. S/E, Allergic reaction: Emergency
Monitoring: When to see Dr - If fever not going down in spite of Tylenol in 24 hours, if fever
exceeds 40.5, if fever persists more than 3 days or any other symptoms develop like ear pain,
coughing etc.
Answer 5th minute question: If not controlled may lead to seizure known as “Febrile seizure”
Recommend self-care measures: Give her plenty of fluids, avoid excessive clothing, tepid water
sponging
Follow up
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Case 1 - Tylenol liquid (Acetaminophen)
Usual dose
10-15 mg/kg every 4-6 hours when needed
(No greater than 5 doses per day or 65
mg/kg/day)/use wt chart from package
Uses
Treatment fever in children
Treatment of pain in children
Major interactions
Enzyme inducers: (Phenytoin, Barbiturates,
Carbamazepine, Isoniazid) decrease
acetaminophen levels.
Contraindications
Hypersensitivity
Malnutrition / Fasting
Common side effects
Generally well tolerated
Serious or rare side effects
Overdose symptoms:
Nausea
Vomiting
Hepatotoxicity
Death
Special
Counselling
•
What is bothering you? How can I help you? (Pay close attention to their main complaint as you will
need to address it first)
Did you talk to your doctor about it?
Ask the patient relevant questions to rule out red flags
• How long has the fever been present?
• How old is your son/daughter?
• How high is the fever?
• Is the fever associated with stiff neck or seizures, localized pain, redness, swelling or
heat?
• Is your child very ill or excessively fussy?
• Does he/she have persistent wheezing and cough?
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• Is he/she confused or delirious?
I recommend that you give them a medication called “TYLENOL” in a liquid form. It contains
“ACETAMINOPHEN” in concentration of 160mg/ml
ACETAMINOPHEN is mainly indicated for:
o Treatment of fever
o Treatment of pain
•
You will need to give the dose according to weight. Give ‘x’ ml up to 4 times a day when needed.
Don’t exceed 5 doses per day. “ALWAYS READ THE DIRECTIONS ON THE LABEL AND TELL THE
PATIENT AS THERE MIGHT BE DIFFERENCES BETWEEN DIFFERENT PACKS AND MANUFACTURERS”.
ACETAMINOPHEN can be “Taken with or without food”
You can give the medication for up to 3 days (72 hours). If the fever still persists after 3 days or if
the fever goes over 40.50C, then I would recommend that you go and see your doctor
•
Along with the beneficial effects, it has a few side effects which you may or may not experience
SIDE EFFECTS: (TELL 2 COMMON SIDE EFFECTS & THEIR MANAGEMENT AND 1 RARE SIDE EFFECT
AND ITS MANAGEMENT)
o Common side effects include:
Generally very well tolerated
 Stomach upset. Take the medication with food
o Rare side effects include:
 Severe allergic reaction (EMERGENCY)
“DO YOU HAVE ANY QUESTIONS OR CONCERNS SO FAR?”
•
Along with the medication there are few “SELF-CARE MEASURES” that you can take to help with
your condition such as:
o Encourage the child to drink lots of fluids
o Keep the child cool by removing excessive clothing
o Sponge them with tepid water
•
Follow up: (Always ask patient’s permission first)
“Would you like me to call you and see how you are doing with the medication?”
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Sample
Questions for
some of OTC
topics
“Asking the right question, in the right form, at the right time, LEADS
TO THE ANSWER”
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1. SMOKING CESSATION
QUESTIONS TO BE ASKED BEFORE RECOMMENDATION
•
How soon after waking up do you smoke?
•
How many cigarettes a day do you smoke?
•
What is the nicotine content of your cigarette?
•
Which is your most satisfying smoke of the day like early in the morning, after eating or any other?
•
When do you smoke the most?
•
What trigger your smoking habit?
•
How often do you inhale smoke?
Reference: www.nicorette.ca
BEFORE SELECTING NRT GUM, PATCH OR INHALER, GIVE PATIENT A CHOICE
•
Do you smoke at regular intervals? If yes, then patch
•
Are you looking for once a day convenience? If yes, then patch
•
Do you want something specifically for your craving? If yes, then gum
•
Do you have difficulty in controlling the hand to mouth reflexes? If yes, then inhaler
2. RED EYE
•
Describe your red eye condition.
•
How long have you been experiencing this?
•
Is there any pain or vision change recently?
•
Is it due to some kind of injury like chemical exposure, foreign body exposure or heat exposure?
•
Do you wear contact lenses?
•
Is there any discharge coming out from the affected eye?
•
How is the discharge? Is it purulent or watery?
•
If it’s watery then does eye feel itchy?
•
Do you feel gritty or sandy particles in your eyes?
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Red Flags:
Pain, vision change, injury, any unusual exposure, contact lances, watery discharge without itching
(Viral conjunctivitis), no symptomatic resolution within 2 days, symptoms get worse
DIAGNOSIS:
•
Purulent discharge - Bacterial conjunctivitis
•
Watery discharge with itching - Allergic conjunctivitis
•
Watery discharge without itching - Viral conjunctivitis
3. INSOMNIA
•
Tell me more about your lost sleep.
•
How much total time you sleep per day including day time and night time?
•
Do you awake in between or you have difficulty in going sleep?
•
How long have you been experiencing this loss of sleep?
•
Is there any recent change in your life that may interfere in your sleep like change in job schedule,
work stress, pain, medication, death in family etc?
•
How about coffee, alcohol and smoking?
•
Is there anything else that I should be aware of?
Red flags
•
Age less than 12 years
•
Insomnia associated with any chronic disease like asthma
•
OTC ineffective after 3 evenings of therapy and treatment still required, OTC required for more
than 14 consecutive days,
•
Confusion develops after self-care therapy in elderly
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Health-care Professionals
Stations
Doctors, Nurses, Care- takers,
Physiotherapist etc.
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Detailed template for Doctor Station
INTRODUCTION

Introduce yourself

Identify the Doctor

Identify the Patient
INFORMATION GATHERING
o MEDICAL INFORMATION
 Reason for prescribing and medical condition
 Other Medical conditions
 Allergies, Severity of allergy
 Rx Medications
 Herbal, OTC Medications
 Renal function
 Pregnancy and breastfeeding if women 18 - 48
o LIFESTYLE INFORMATION (If the doctor knows)
 Caffeine, Alcohol, Smoking, Exercise, Diet
CHECKING REFERENCE
Ask permission to look at reference and get back to the Doctor
STEPS TO FOLLOW IF IT IS A DRUG RELATED PROBLEM AND RECOMMEND AN ALTERNATIVE
o Is the drug right for Current Diagnosis, Age, Gender & Weight?
o Is the drug right for its dose frequency?
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o Route of administration
o Is it compatible with current medical conditions?
o Allergy?
o Current lifestyle and social habits
o Once the drug related problem is identified then check how to manage it
o Pharmacological alternative
o Non-pharmacological alternative
o For pharmacological alternative: Look in the reference available. Algorithms Guidelines
for treatment of particular condition
*** Inform doctor of why prescribed drug is not appropriate choice and give your recommendation
as follows:
Name of drug, strength, dosage and duration of treatment
*** Document neatly on the sheet provided
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Scenario / Background Information: Case 42
Door Note: Doctor is waiting inside for your suggestions and assistance, proceed inside and do as you
would do in regular practice.
Reference: CPS, Patient profile
Dr’s Info
Opening statement: My name is Dr Lee. I wrote Rx for Julia Scott
If ok to dispense go ahead and if there are any questions concern I am here to discuss and
make the necessary change if needed.
Rx for AOM (Condition only when asked)
Recurrent only if asked ** Candidate should know from profile (Amoxicillin 15 days back)
MC : Everything in profile if asked weight or any other questions
Allergy : As per profile
Liver Fn: Normal Kidney Fn: Normal
Medications: As per profile
OTC : None
Pregnant: NA
Breastfeeding: NA
Life style and social habit: Not known
Question at 5 minute bell:
Mannerism: Normal
Special Note:
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XYZ Medical Clinic
Xxxx
Xxx
xxx-xxx-xxxx
Sam Baptist
Xxxx
Rx
Cefprozil suspension
100mg po bid for 5 days
Dr. Lee, Martin
PATIENT RECORD
PATIENT: Julia Scott
ADDRESS: xxxx
PHONE: xxxx
AGE: 18 Months
SEX: Female: Weight: 11kg
ALLERGIES: NKA
MC: AOM
PHYSICIAN: Dr. J. Brown
Live Fn: Normal
Kidney Fn: Normal
No. Medications - Directions
DR
Q
Auth
Rem
Original Refill
Last
Filled
150ml
15 days
back
Amoxicillin Susp. 250mg/5ml
1
3.5 ml three times daily for 10 days 150 Dr LEE,M 150ml Zero
Zero
Discard rest
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Ideal Response:

Ask the reason for Rx

After going through profile, realise recurrent AOM

Ask about liver/kidney function and culture and sensitivity tests

Ask weight to determine the correct dose

Check reference: TC

From TC found (Management of AOM using a risk factor-based Approach - Figure 1) Doctor
needs to prescribe alternate agent for treatment failure or recurrence within 1 month.
(Foot note)

Alternate from Table 1: Cephalosporin: 3 choices

Doctor wanted Cefprozil; Calculate dose: 30mg/Kg/Day: Comes to 11X30=330/2 so 165mg
bid.
For 10 days (Determine length of treatment from end of the table: Foot note says for less
than 2 years need 10 day treatment)

Tell doctor that the prescription is of lesser dose and should be for 10 days quoting
reference used.

Document: Change to Cefprozil 165mg (3.3ml po bid for 10days), Signature and date.

Follow up
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Cases for Management:
SP or SR coming for information only
You need to check references on table
and deal with the situation
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Scenario/Background: Case 51
Patient complains that Medication is not working for him.
Reference: PSC, Patient profile
Patient Profile:
Repeats
No.
Medications –
Directions
1 Apo-Salvent 100 mcg
Dispensing Intervals
Qty Physician
Authorized Remaining Original
1 J. Brown
1
Refill Last
Frequency Filled
0
Upon questioning it was found that the puffer was never shaken prior to use and never used before
workouts.
Ideal Response:



Ask appropriate questions to find out whether the patient is using it in correct way or not.
Explain correct technique of using the puffer
Follow up
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Scenario / Background Information: Case 52
A patient is coming with an early refill request
Reference: Patient profile
Patient Profile:
Medications –
No.
Directions
1
Ativan 1 mg
Repeats
Dispensing Intervals
Qty Physician
Authorized Remaining Original
30 R Tan
1
1tab OD HS
1
Refill
Last
Frequency Filled
1 month
ago
2weeks
ago
Ideal Response:

Offer private confidential area

After asking appropriate questions identify the patient has increased the dose from 1tab OD to
2tab OD

Explain the need to visit the doctor

Do not give out the refill, may or may not advance a 3 days pill
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Demonstration of
devices or products
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Demonstration of Devices
It is expected that a pharmacist is able to demonstrate how to use a device to the patient. The correct
usage of the device can make a difference to patient’s health and may determine the success or failure
of therapy.
It is an important aspect of practice and candidates must try to acquire significant proficiency in this
area.
Taking the guesswork out of the exam
A lot of times, the question is assumed to be: What kind of demonstration can one expect in the exam?
It is not prudent to make a guess. The best way is to try to eliminate guesswork. How many common
devices are there which may need a demonstration? Just prepare all of them. Finally, be prepared to
deal with a situation where you are not familiar with that device.
How to effectively demonstrate a device
There are 2 techniques that if implemented can make your demonstration highly effective, organized
and easy to understand for the patient.
Technique #1: Start with explaining different parts of the device
Before you start demonstrating a device, explain to the patient different parts of the device.
For example: If you are explaining Ventolin inhaler, first explain different parts of the inhaler like:
I am now going to show you how to use the Ventolin inhaler. Before I explain, let me first show you the
different parts of this device. Is that okay?

This part is the canister which has the actual medication in it

This part is called the mouth piece which you put in your mouth and seal with your lips around it

This part is the cover for the mouth piece.
Why is this technique useful?
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When you explain the device, patient is not confused when you refer to different parts and hence you
do not have to digress to explain different parts while showing how to use.
Technique #2: Break the demonstration in 3-4 easy steps
Breaking down the demonstration into few simple steps makes it easier for the patient to understand.
Also, it allows you to pause and ask the patient if he/she is following what you are saying.
For example, if you are demonstrating blood glucose monitor, it can be broken down into 4 parts for
ease of understanding
I will now explain you how to use the blood glucose monitor in 4 easy steps:

Preparing yourself to inject & get blood

Preparing blood glucose monitor for reading

Injecting yourself and getting a reading

Safe disposal
Then you can explain each component in detail.
Therapeutic Tips from Real world Practice

If you have never seen the device before, do not panic. Ask the patient to give you a moment and
read the leaflet. If you can easily demonstrate it, great. If not, just break the demonstration into few
simple steps. Read one step at a time and then explain to the patient.

At end of each step, ask patient: Are you with me? Are you following? Do you have any questions
till now?
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List of common demonstration devices and further reading
Below is a list of common devices that you should know how to demonstrate. By all means, it is not
complete but covers major devices. Add your own to the list. YouTube® carries demonstration videos for
a lot of devices. Use Google® to print monographs and graphical depiction of usage for different
products.
Demonstration of Devices
Sr. No Type
1
Blood glucose monitor
2
Eye drops
3
Inhalation
4
Rectal
5
Ear drops
6
Transdermal patch
7
Pump spray
8
Nasal spray
9
Misc
Specific
One Touch, Contour
Fucidin viscous eye drops
Aero chamber
Ventolin HFA
Adair diskus
Symbicort
Spiriva
Nicotine Inhaler
Proctofoam HC
Anusol suppository and ointment
Entocort Enema
Ciprodex
Polysporin
Nicotine Patch
Nitro-glycerine patch
Fentanyl patch
Nitro-glycerine pump
Androgel pump
Estrogel spray
Miacalcin Nasal Spray
Zomig Nasal Spray
Omnaris
Migranal
Apo-Butorphanol
Insulin pen
Epipen
Twinject
Penlac
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Door Note
Person is sitting Inside.
There is no DRP.
Demonstrate as you
would in regular
practice.
We picked few devices and highlighted the important points that you need to know about them.
These are key points in patient counseling that you should do in your everyday practice. Do
whatever is not mentioned here on your own:
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Case 65. Aero chamber

Aero chamber is a transparent tube which has
two open ends

Check the device for foreign particles before
using it

Remove the mouthpiece from aero chamber as
well as inhaler

Shake the inhaler vigorously

Attach the mouthpiece of inhaler to the rubber end side of aero chamber.

Put the mouth piece of aero chamber in your mouth and cover it with lips.

Breath normally thorough aero chamber

Depress canister once to release 1 puff into aero chamber

Let the patient inhale 4-6 times to take the full dose

Continue breathing in and out through the mouth piece without removing aero chamber mouth
piece from your mouth

If the patient is breathing too fast the device will make a whistling sound, this means slow down

Aero chamber mouth piece is a one way valve, so patient can breathe in and out normally

Wait for a minute between each dose and shake inhaler before each dose

Clean aero chamber once in a week

Never run water through aero chamber. Dismantle rubber ring and cap and put into gentle motion
warm water

Don’t put cotton or tissue inside the aero chamber to dry, let it air dry

After completely drying the aero chamber, place the rubber ring and cap in its original position
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Case 66. Epipen

Right before use, remove blue cap (Safety cap)

Avoid touching orange tip (touch sensitive)

Swing and jab into the outer thigh

Designed to be used on top of clothes
(Needle is long and strong)

After firing into the outer thigh, leave it there
for few seconds before removing it

After removal, massage the area

Call 911 and let them know that you have
used an Epipen

Side effect include: Tremors, heart racing,
and sweating

Make sure to check expiry date

Epipen junior to be used by patients less than 30 kg

Stay in hospital proximity within the next 48 hours after experiencing the anaphylaxis shock
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Effective use of
Basic
References
&
Non-Interactive
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Effective use of Basic References
In this section you will learn about the different common references and the
main purpose and layout of each one of them. It is very important to
practice using these references in order to get used to their layout and how
to retrieve different kinds of information
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Compendium of Pharmaceuticals and Specialties known as the CPS. It’s the main reference that you
refer to in Canadian pharmacy practice for various forms of information. It is very important to
understand the different sections in the CPS and the general layout of the book. It’s divided into:

The Green Pages: An alphabetical, cross-referenced index of brand and generic names of
products available in Canada including references to CphA monographs. Also, integrated in this
section are products which are discontinued

The Pink Pages: A listing of diseases and conditions and the generic names of drugs used to
treat them

The Lilac Pages: Valuable clinical information and practice tools to assist health care
professionals use drugs safely and effectively

The Yellow Pages: Contact information for:
o Poison control centers
o Pharmaceutical manufacturers (includes product listings)
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o Health organizations published in e-CPS only

The White Pages: They are divided into 4 categories:
o Monographs
o Product identification
o Appendices
o Glossaries
o MONOGRAPHS: The monographs are divided into either one of two:
1. Product Monographs
2. CphA Monographs
1. Product Monographs: The monographs are prepared by the manufacturers and approved by the
Therapeutic Product Directorate, Health Canada. It also includes information to the patient (only in eCPS) For instance:
Coumadin® PR - Warfarin sodium (Anticoagulant) Bristol-Myers Squibb
Pharmacology
Pharmacokinetics
Indications
Contraindications: Pregnancy, Hemorrhagic Tendencies or Blood Dyscrasias
Warnings: Lactation
Precautions: e.g. : Periodic determination of PT ratio/INR
Drug Interactions: All kind of medications and other as well
Pregnancy: See contraindications
Adverse Effects: Body as a Whole, Central and Peripheral Nervous Systems, Gastrointestinal,
Liver and Biliary. Tabular form with %
Overdose: Symptoms and treatment
Dosage:
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Supplied: 1mg: 1 mg
Each pink, round, biconvex tablet, one side bisected and imprinted with “COUMADIN” and “1”,
And the other side blank, contains: crystalline warfarin sodium 1 mg.
Nonmedical ingredients: D&C Red No. 6 Barium Lake, lactose anhydrous, magnesium
stearate and pre-gelatinized tapioca starch. Bottles of 100, 250 and 1000.
Protect from light and moisture. Store at room temperature (15 to 30°C). Dispense in a tight,
light-resistant container as defined in the USP.
2. CphA Monographs: These individual drug or drug class monographs are written by editorial
staff and reviewed by expert physicians and pharmacists.
Product Identification: Full-color reproductions of products selected by manufacturers whose
monographs appear in the Product Monograph section. This is an essential tool for accurate
identification of pharmaceutical products.
Appendices: Health Canada drug regulatory and monitoring programs reporting and request
forms can be found in the Appendices.
Glossaries: Glossaries of medical, Latin and microorganism abbreviations are located after the
Appendices.
TIP 1: Keep in mind that when you look up a certain medication in the Green Pages, it will not
refer you to a page number, but it will refer you to the name you can find the medication
under. (whether brand name or generic name) Then you will need to go to the corresponding
letters and find your medication. On the top of the page you will find the first few letters, this
way you know where you are looking.
TIP 2: If you are using e-CPS, it will be easier for you to retrieve in information since in the top
of the page you will find all the different sections mentioned in the page according to order.
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In this Chapter:
 You will learn about different types of non-interactive stations
 How to break down each type of the non-interactive to easily
tackle it
 Different approaches and principles to find the right answer
There are four main types of non-interactive
stations:
 Prescription checking
 Dispensing checking
 Article reading
 Fill in the Blanks
In order to master the non-interactive stations you will need to understand
the different references and how to find the information you need in each
one of them. Also you will need to know where to look to answer your
questions. Please refer to section titled ‘Basic references and How to use
them effectively’
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1. Prescription Screening
Prescription screening is one of the common non-interactive stations that might come across in your
OSCE exam. In addition to that it is part of the routine work that you will perform in your everyday
practice once you are a fully licensed pharmacist.
But, what is prescription screening?
Basically, it’s checking the appropriateness of each prescription for two main points, legally &
therapeutically.
What do you need to look for?
There are few points that you need to check in each and every prescription that you come across.
These include:
Who wrote it?
Are they authorized to prescribe such medication?
Are they in Canada or USA?
When did they write it?
Is this medication appropriate for the patient (Gender, age, condition)?
Is the direction of use correct?
Is the medication dosage form and strength correct?
All these questions and many other should pop in your mind once you want to check a prescription for
its appropriateness. It might be overwhelming now, but once you see an example, it will help you
understand it more effectively.
TIPS: To master this section you need to practice how to use the CPS effectively. You need to know
where to look in order to find the piece of information you need. Otherwise, it will be very
challenging!!
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Read the following example carefully:
Note: Document all errors in case of one or more errors in one Rx.
Doctor’s name
Address XXX XXX
Ontario
Date
Patient’s name
Rx
Lipitor 20mg
Take 1 Tablet Once Daily
Mitte: 100
Dr. Signature
Now in above Rx:
1) What if Lipitor is missing?
Answer: problem
Description: No drug specified.
2) What if 20 mg is missing?
Answer: problem
Description: No strength specified.
3) What if “Take 1 Tablet once daily” is missing?
Answer: problem
Description: No dosing information specified.
4) What if “mitte: 100” is missing?
Answer: problem
Description: No quantity specified.
5) What if everything is perfect?
Answer: No problem-May be processed as written.
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6) What if Rx written for more than 1 person in 1 order?
Answer: problem
Description: prescription written for more than one person in one order is illegal.
7) What if written as Lipitor for Hypertension?
Answer: problem
Description: Inappropriate medication / indication.
8) what if written insert Lipitor Per rectally?
Answer: problem
Description: Inappropriate route of administration.
9) What if written Lipitor 200 mg?
Answer: problem
Description: Medication overdose, inappropriate strength / dose specified.
10) In case of narcotic prescription what if refill is given?
Answer: problem
Description: Inappropriate refills specified OR Refills not valid OR Refills are not allowed.
Dispensing
check
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This is another form of non-interactive practice that you may come across.
It is very crucial in your everyday practice once you are fully licensed
pharmacist. Basically, you double check everything at the end stage before
dispensing the medication to the patient. Assuming that you ruled out any
type of interaction possible and that it is the right medication for the
patient, you want to double check that the medication labeled matched the
actual prescription and that there is nothing missed in the process.
You usually check and verify:






Doctor’s name (Including spelling mistakes)
Patient’s name (Including spelling mistakes)
Medication dispensed (Strength & brand)
Quantity dispensed
Refills
Physically check that the vial contents match the stock bottle
In this section, you highlight the error, and what is the correction.
The following example should help clear things up:
OSprep Pharmacy
XXXXXXXXXXXX
Date
Patient name
Dr.Name
Date: Current
Dr Name
Medication being dispensed
Sig: XXX
Qty: X
R: X
Patient: Name
Medication XXX
Sig: XXX
M: X
R: X
Dr. Signature
You need to check the label to your left and verify it with the prescription to your right.
1) If doctor’s name was incorrect?
You write “Doctor Name should be XXX”
2) If patient’s name was incorrect?
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You write “Patient name should be XXX”
3) If medication dispensed was incorrect?
You write “Medication dispensed should be XXX”
4) If quantity dispensed is incorrect?
You write “Quantity dispensed should be XXX”
5) If repeats on vial are incorrect?
You write “Repeats authorized should be XXX”
6) If contents of the vial don’t match the stock bottle?
You write “Medication dispensed should be filled from stock bottle”
7) If labels on the vials are reversed?
You write “Labels on vials should be interchanged”
Hopefully by now you get the big picture of what you task is.
Following are some exercises for your own practice. Find the corrections that need to be made, and
match your answer with the answers in the attached appendix. (Assuming the contents of the vial
matches the stock bottle)
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